From the *Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands; †Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; §Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; ¶Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; ∥Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; and ‡Expertise Center Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, the Netherlands

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Abstract

IntroductionFemale sex workers (FSWs) are at risk for human papillomavirus (HPV)–induced diseases but are currently not targeted by the HPV vaccination program in the Netherlands. We explored determinants of their intention to get vaccinated against HPV in case vaccination would be offered to them.MethodsIn 2016, FSWs 18 years and older having a sexually transmitted infection consultation with the Prostitution & Health Center (P&G292) in Amsterdam, either at the clinic or at their working location, were invited to complete a questionnaire assessing sociopsychological determinants of HPV vaccination intention (scale ranging from −3 to +3). Determinants of HPV vaccination intention were assessed with univariable and multivariable linear regression. In addition, we explored the effect of out-of-pocket payment on intention.ResultsBetween May and September 2016, 294 FSWs participated. The median age was 29 years (interquartile range, 25–37 years). Human papillomavirus vaccination intention was high (mean, 2.0; 95% confidence interval [CI], 1.8–2.2). In multivariable analysis, attitude (β = 0.6; 95% CI, 0.5–0.7), descriptive norm (β = 0.2; 95% CI, 0.1–0.3), self-efficacy (β = 0.2; 95% CI, 0.1–0.3), beliefs (β = 0.1; 95% CI, 0.0–0.2), and subjective norm (β = 0.1; 95% CI, 0.0–0.2) seemed to be the strongest predictors of HPV vaccination intention (R2 = 0.54). Human papillomavirus vaccination intention decreased significantly to a mean of 0.2 when vaccination would require out-of-pocket payment of €350.ConclusionsThe HPV vaccination intention among FSWs seems relatively high and is most strongly constituted in attitudinal, normative, and self-efficacy beliefs. Out-of-pocket payment will probably have a negative impact on their HPV vaccination acceptability.